Although the web-based program is still being built, Dr. Sadun says, “Fellows who participated in the skills-based workshops showed increased confidence working with young adult patients, as well as increased competence when tested with an Objective Structured Clinical Examination transition station; whereas fellows who participated only in the one-time lecture showed an increase in confidence without a commensurate increase in competence.”
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Explore This IssueDecember 2020
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Now in the study’s third year, the team is working to develop web-based resources to provide rheumatology fellowship programs nationwide with access to the transition curriculum.
Fellowship Curriculum Addresses Health Disparities
“Health disparities are pervasive in medicine, and rheumatology is not immune,” Irene Blanco, MD, MS, says. Example: Lupus patients’ disease activity is higher in patients who are Black, Latinx, Asian and Native American. Also, lupus patients with a lack of formal education, those living in poverty and those without health insurance have increased disease activity, morbidity and mortality.
Healthcare disparities for lupus patients have long been recognized, with some of the first landmark studies now 20 years old. “Yet we are in a situation in which Black patients are still doing worse. So although we have extensively described the problem, we have not done enough to fix it,” she says.
As rheumatology fellowship program director at Albert Einstein College of Medicine in The Bronx, N.Y., Dr. Blanco wanted to understand how to use didactic curriculum to increase educational awareness of health disparities among fellows, as well as faculty, “who have the power to better serve underserved rheumatology patients.”
Currently in year 3 of the study, Dr. Blanco and her team have interviewed fellows to understand the effect of social determinants of health on rheumatology patients. They have discovered three common themes: Fellows were at a loss for what to do to address health disparities, a scarcity of role modeling exists among faculty recognizing issues of disparate care, and learning about health disparities has been haphazard and informal.
Rheumatology fellowship program directors attending the 2019 ACR Division & Program Directors Conference were also interviewed for the study to assess their needs regarding healthcare disparity responses. Through this needs assessment, Dr. Blanco and her team learned few rheumatology program directors were prepared to specifically address health disparities through actions, such as advancing health literacy.4
“These data showed that faculty may not necessarily pick up on when a patient is feeling certain biases that may come up in an encounter,” Dr. Blanco says.